スダ　サトシ   SUDA Satoshi   須田　智    所属   埼玉医科大学  医学部 国際医療センター　神経内科・脳卒中内科    職種   教授
論文種別	学術雑誌(原著)
言語種別	英語
査読の有無	査読あり
表題	The relationship between stroke severity and prior direct oral anticoagulant therapy in patients with acute ischaemic stroke and non-valvular atrial fibrillation
掲載誌名	正式名：EUROPEAN JOURNAL OF NEUROLOGY ISSNコード：1351-5101/1468-1331
出版社	WILEY
巻・号・頁	24(11),1399-1406頁
著者・共著者	Y. Sakamoto,S. Okubo,C. Nito,S. Suda,N. Matsumoto,A. Abe,J. Aoki,T. Shimoyama,Y. Takayama,K. Suzuki,M. Mishina,K. Kimura
発行年月	2017/11
概要	Background and purposeAnticoagulant treatment with a vitamin K antagonist (VKA) has been reported to reduce stroke severity when patients with atrial fibrillation (AF) suffer acute ischaemic stroke (AIS). Direct oral anticoagulant (DOAC) therapy also has the potential to reduce the initial severity of AIS. However, the effect of DOAC therapy on the severity of AIS is not well known. The aim of the present study was to investigate the effect of DOACs on initial stroke severity in patients with AIS and non-valvular AF. MethodsFrom March 2011 to July 2016, consecutive patients with AIS having non-valvular AF were recruited. The effects of prior DOAC treatment on severity were assessed by multivariate logistic regression analyses. ResultsA total of 484 patients [208 women; median age 79 (interquartile range, 71-85) years; National Institutes of Health Stroke Scale (NIHSS) score 9 (interquartile range, 3-20)] were enrolled. Of these, 352 (73%) were on no anticoagulant medication, 54 (11%) were undertreated with a VKA, 35 (7%) were sufficiently treated (admission prothrombin time-international normalized ratio: 2.0 for patients <70 years old and 1.6 for 70 years old) with a VKA and 43 (9%) were on a DOAC. The initial NIHSS score (median 10 in patients with no anticoagulation, 13 in undertreated VKA, 7 in sufficient VKA and 6 in DOAC, P = 0.018) was different among the groups. Multivariate analysis showed that DOAC was independently and negatively associated with severe (initial NIHSS score 10) stroke (odds ratio, 0.39; P = 0.041), compared with no anticoagulant therapy. ConclusionsDirect oral anticoagulant treatment prior to the event should reduce initial stroke severity in patients with AIS and non-valvular AF.
DOI	10.1111/ene.13405
PMID	28799181